Repetition of attempted suicide: The performance of the Edinburgh predictive scales in patients in Oxford
Hawton K., Fagg J.
Non-fatal suicidal behaviour is often repeated, especially in the first few months after an attempt. Repetition increases the risk of eventual completed suicide. Scales have been developed to predict the risk of repetition, particularly in the short-term. We have tested a recently developed scale from Edinburgh in two one-year cohorts of patients assessed in routine clinical practice following attempts that resulted in referral to the general hospital in Oxford. The scale was tested in both its clinical and research (weighted item) versions, first, as originally evaluated by its originators and, second, using only first attempts by individual persons rather than any episode (i.e., including repeat episodes) during the study periods as the index events and a standard one year follow-up period, rather than within a calendar year period. We also compared the performance of the scale with a short scale, again from Edinburgh, which was developed in the 1970s. The new Edinburgh Risk of Repetition Scale performed as well as in the original evaluation in only one of the cohorts, the performance being considerably inferior in the other cohort. Using a person-based approach resulted in inferior performance, as did using a standard one-year follow-up period. There was little difference in the performance of the scales and the more simple original scale from Edinburgh when both were analysed on the same basis. While current risk of repetition scales can be useful in research investigations, there is a need for new approaches to assessing risk. Attention to personality and psychological risk factors is likely to be a useful line of research in this regard. © 1995 Kluwer Academic Publishers. Printed in the Netherlands.